Explore Policy Proposals
From new public insurance models to strategies for strengthening private insurance, the interactive compendium offers insight into the major ideas and evidence shaping the national conversation.
Explore and Compare Policy Proposals
This compendium is divided into three key sections, each highlighting a different approach to long-term services and supports (LTSS) financing reform.
The first section focuses on legislative proposals aimed at expanding or improving public LTSS coverage, including efforts to establish new public insurance programs or modify existing ones.
The second section presents legislative proposals designed to strengthen the private long-term care insurance market, such as tax incentives, regulatory reforms, and market stabilization strategies.
The third section includes major commission reports and research papers that have shaped the policy conversation over the past three decades.
Together, these sections provide a comprehensive overview of policy ideas and evidence aimed at addressing the financial challenges associated with aging and long-term care needs in the United States.
How to use this search tool
Use the drop-down menus to filter proposals by options including category, year, or topic. Selecting an option will update the list so you can easily explore proposals that match your LTSS financing interest or objectives.
This compendium organizes proposals by time period to highlight how LTSS financing reform ideas have evolved over the past three decades:
Understanding the proposal date ranges
- 1988–1994: Early federal legislative proposals for LTSS finance reform (Covers initial activity including Medicare/Medicaid expansion proposals and early public coverage reforms.)
- 1995-2006: Several of the federal legislative proposals relating to LTSS during this time period focused on activities to expand the private LTC insurance market and Medicaid reforms which were eventually passed, and therefore not included in the Compendium.
- 2007–2010: Mid-period proposals and the CLASS Act (Includes renewed focus on long-term care financing after a gap in major proposals.)
- 2013–2017: Commission reports and private market innovations
(Captures policy studies, collaborative principles, and early private market-focused solutions.) - 2019–2021: Recent proposals addressing modern LTSS challenges
(Includes middle-income access initiatives, updated social insurance models, and new legislative acts.) - 2022–2024: Most recent policy roadmaps and federal bills
(Represents the latest thinking, comprehensive reforms, and Medicare-related proposals.)
Search results will appear in the table below once you have made your selections.
Please note: Advanced filters like Program Structure, Population Served, and Covered Services are not available for proposals in the Private Long-Term Care Insurance Market due to differences in how these proposals are structured and reported.
Proposal Date Proposals Description Category
2025 Ronald Reagan Alzheimer’s Breakthrough Act of 2004 (S. 2533, H.R. 4595) Same as S. 1335, but no cost estimate and does not
include cafeteria plan/FSA. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 LTC and Retirement Security Act (S. 1335) Companion bill to H.R. 6405 (above). Amend the IRC of 1986 to allow individuals a deduction for qualified LTC insurance
premiums, the use of such insurance under cafeteria plans and flexible spending arrangements. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 LTC and Retirement Security Act, 2003 (HR 2096) Companion bill to H.R. 6405 (above). Amend the IRC of 1986 to allow individuals a deduction for qualified LTC insurance
premiums, the use of such insurance under cafeteria plans and flexible spending arrangements. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 Improving Long-Term Care Choices Act of 2005 (S. 1602) Companion bill to H.R. 6405 (above). Amend the IRC of 1986 to allow individuals a deduction for qualified LTC insurance
premiums, the use of such insurance under cafeteria plans and flexible spending arrangements. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 Long-Term Care Improvement Act of 2006 (H.R. 6405) Amend the IRC to exclude from gross income distributions from an individual retirement account and other tax-exempt retirement
plans used to pay LTC insurance premiums. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 LTC Act of 2005 (H.R. 976, S. 1706) Amend the IRC to exclude from gross income distributions from an individual retirement account and other tax-exempt retirement
plans used to pay LTC insurance premiums. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 Comprehensive LTC Support Act or 2006 (H.R. 6211) Amend the IRC to allow a deduction from gross income (available for taxpayers who do not itemize deductions) for the cost of LTC premiums for the taxpayer and certain family members. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 LTC Tax Reduction Act (H.R. 4220) Amends the IRC to exclude from gross income distributions from an individual retirement account and other tax-exempt retirement
plans used to pay LTC insurance premiums. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 LTC Support and Incentive Act (H.R. 2935) Amend the IRC to: (1) allow a tax deduction from gross income for 50% of the LTC premiums paid under a qualified LTC insurance contract for individuals under age 65 (increases the deduction percentage to 75% for premiums paid for individuals age 65+); (2) permit qualified LTC insurance contracts to be offered in a cafeteria plan and FSAs under certain conditions; (3) allow
a nonrefundable tax credit of $4,000, subject to a phase-out for incomes exceeding $150,000 (joint returns) or $75,000 (individuals), for each individual age 65+ who has been certified as having LTC needs for at least 180 consecutive days in a taxable
year and for whom the taxpayer is acting as a caregiver; and (4) mandate certain consumer protections for insurance contracts. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 LTC and Retirement Security Act of 2005 (H.R. 2682) Amend the IRC to: (1) allow a tax deduction from gross income for LTC insurance premiums; (2) include LTC insurance in employee benefit cafeteria plans and flexible spending arrangements; (3) allow a tax credit for certain LTC costs; (4) set forth certain consumer protections for LTC insurance contracts; and (5) allow tax free exchanges of LTC insurance contracts. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 Amends the IRC of 1986 (H.R. 1150) Allow individual taxpayers a tax credit for certain long-term health care insurance premiums and expenses paid for the
taxpayer, the taxpayer’s spouse, or dependents. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 Healthcare Enhancement for Local Public Safety Retirees Act (H.R. 2177) Amend the 1987 IRC to permit tax-free distributions up to $5,000 from government retirement plans for premiums for LTC
insurance for public safety officers. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 Simple Cafeteria Plan Act (S. 723) Allow premiums for LTC insurance to be paid on a pre-tax basis through section 125 cafeteria plans and FSAs. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 LTC Affordability and Security Act (H.R. 3363, S. 2337) Allow premiums for LTC insurance to be paid on a pre-tax basis through section 125 cafeteria plans and FSAs. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 LTC Trust Account Act (S. 1809, H.R. 3088) Allow individuals to use funds from 401(k), 403(b) and 457 plans to pay for LTC insurance without penalty for early withdrawal and without paying taxes on the amounts withdrawn. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 LTC Trust Account Act (S. 504) Create a new type of savings account (a LTC Trust Account). Individuals can contribute up to $5,000/year and receive a refundable 10% tax credit on the contribution. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 Qualified LTC Fairness Act of 2007 (H.R. 2582) Establish above-the-line tax deduction for LTC insurance and service expenses; does not require individuals to itemize deductions or have medical expenses that exceed 7.5% (now 10%) of AGI. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 Alzheimer’s Family Assistance Act of 2007 (S. 897) Amend the IRC to provide a nonrefundable tax credit for LTC insurance premiums. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 LTC and Retirement Security Act of 2008 (H.R. 5559) Amend the IRC to provide a nonrefundable tax credit for LTC insurance premiums. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 LTC Family Accessibility Act (S. 3365) Amend the IRC to provide a nonrefundable tax credit for LTC insurance premiums. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 Tax Relief for LTC Act (H.R. 6237) Amend the IRC to provide tax credit for LTC premiums and for family caregivers living with a family member or dependent with LTC needs. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 Simple Cafeteria Plan Act (S. 988) Reintroduce S. 723 from 109th Congress. Amend the IRC of 1986 to allow small businesses to include LTC insurance in cafeteria plans. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 LTC Retirement and Security Act (H.R. 6005) Create tax deduction for LTC insurance premiums, starting at 25% in 2013 and increasing to 65% in 2015, and 100%
thereafter. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 LTC Affordability Act (S. 4820) Amend the IRC to exclude up to $2,500/year from gross income distributions from eligible retirement plans if used to purchase LTC insurance or chronic illness benefit under a life insurance policy. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 Long-Term Care Partnership Program The program allows Medicaid to disregard assets in an amount equal to the insurance benefit payments made under a Partnership-qualified (PQ) LTC insurance policy if and when someone with a PQ plan exhausted their private coverage and applied for Medicaid. Legislative Proposals for the Private Long-Term Care Insurance Market, Non-Tax Related Proposals to Expand Private Market Solutions Private Market Incentives, Private-Public Partnership
2025 Improving Access to Long-Term Care Insurance Act (H.R. 8820) Allow taxpayers to take a deduction for LTC insurance premium amounts without satisfying the requirement that medical expenses exceed 7.5% of AGI. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Tax Deductions
2024 Mark Warshawsky, National Affairs: Financing Long-Term Care Directs public program resources to those who cannot afford care and otherwise encourages self-reliance among those who could afford care through private funds or insurance. Commission Reports and Research Papers Awareness campaign, Medicaid enhancement, medicaid reform, No age limits, None specified, Not specified/other, Private Market Incentives, Tighten Medicaid, Transforming Structures
2024 The Brookings Institution: Home Care Benefit for Medicare Develop and finance a universal home care benefit program for Medicare beneficiaries, which would have a measurable impact on access for individuals with functional and/or cognitive impairments who do not financially qualify for Medicaid. Commission Reports and Research Papers Add-on to Medicare, Home care and CC only, in proposal, Legislation estimate, Mandatory/universal, Not specified/other, Not specified/other coverage, Older adults (65+), Other Financing
2024 Amend Title XIX of the Social Security Act Seeks to amend title XIX of the Social Security Act to enhance transparency and broaden coverage options for HCBS under Medicaid waivers. Legislative Proposals for Public LTSS Finance Coverage Reform Both federal and state, Home and CC only, Home and community care only, Mandatory/universal, Medicaid enhancement, No age limits, None, None specified, Not specified/other
2023 Amends Internal Revenue Code of 1986 (H.R. 5774) Allow use of HSA funds for LTC expenses. By amending the Internal Revenue Code (IRC) of 1986 to Clarify Treatment of Distributions from Health Savings Accounts (HSAs) for LTC Services. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Use of HSA Funds
2023 HCBS Access Act Expands access to HCBS and ends the Medicaid funding institutional bias by: Requiring state Medicaid programs to provide HCBS at the same level as they must cover nursing facility services. Eliminating the need for HCBS waivers when HCBS becomes a mandatory benefit. Creating additional programs and requirements to support providers who furnish HCBS. Legislative Proposals for Public LTSS Finance Coverage Reform Both federal and state, Home and CC only, Home and community care only, Legislative Proposals for Public LTSS Finance Coverage Reform, Mandatory/universal, Medicaid enhancement, medicaid reform, No age limits, None, None specified, Not specified/other
2023 Better Care Better Jobs Act Creates new programs and funding for state Medicaid programs to improve HCBS and the
direct care workforce by: Requiring states to submit an HCBS infrastructure improvement plan to increase access to HCBS and strengthen the direct care workforce. Increasing federal matching rate for HCBS in states that develop plans and meet specified benchmarks for improvements. Legislative Proposals for Public LTSS Finance Coverage Reform Both federal and state, Home and CC only, Home and community care only, Mandatory/universal, Medicaid enhancement, No age limits, None, None specified, Not specified/other
2023 Medicare for All Act (H.R.3421) Establish a national, single-payer health insurance program to provide comprehensive protection against the costs of health care and health-related services, including a home and community-based LTSS benefit. Legislative Proposals for Public LTSS Finance Coverage Reform Add-on to Medicare, Both federal and state, Comprehensive, Home and community care only, Home care and CC only, Largely federal role, Mandatory/universal, No age limits, None, None specified, Not specified/other
2022 LTC Affordability Act (H.R. 7107) Reintroduces S. 4820 from 116th Congress. Amend the IRC to expand the use of retirement plan funds for purchasing LTC insurance and for other purposes. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Use of Retirement Funds
2022 HELPS Retirees Improvement Act of 2022 (H.R. 7203) Increases from $3,000 to $6,000 the amount of the exclusion from gross income of distributions from a tax-exempt retirement plan for health and LTC insurance for public safety officers. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Use of Retirement Funds
2022 Bipartisan Policy Center: An Updated Policy Roadmap: Caring for Those with Complex Needs Federal Catastrophic Long-Term Care Insurance. Presents a mix of publicly funded programs and private insurance approaches to financing LTSS as a package of solutions designed to be financially and politically viable. Commission Reports and Research Papers Add-on to Medicare, Catastrophic, Comprehensive, Dedicated/earmarked source, Federally regulated exchange, Largely federal role, Mandatory/universal, Medicaid enhancement, medicaid reform, New Program/Separate Admin, New program/separate administration, None specified, Other criteria, Private Market Incentives, Regulation change/new product, Tax clarification, Transforming Structures
2022 Health Savings Freedom Act of 2022 (H.R. 6474) Increases from $3,000 to $6,000 the amount of the exclusion from gross income of distributions from a tax-exempt retirement plan for health and LTC insurance for public safety officers. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Use of HSA Funds
2021 LTC Affordability Act (S. 2415) Ability to use Retirement Account Funds to Pay for LTC insurance premiums without added 10% tax on early distributions. Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions Use of Retirement Funds
2021 Milken Institute: New Approaches to Long-Term Care Access for Middle-Income Households Goal to develop complementary public-private LTSS financing solutions focused on front-end protection provided by the state. Identifies three promising areas for increased financing and delivery opportunities: Medicare expansion solutions, Technology solutions, Public and private LTC insurance solutions. Commission Reports and Research Papers Add-on to Medicare, Comprehensive, Front-end, in proposal, Largely federal role, Legislation estimate, Older adults (65+), Private Market Incentives, Tighten Medicaid, Transforming Structures
2021 Well-Being Insurance for Seniors at Home Act (H.R. 4289) Create a universal, catastrophic LTC insurance program meant to: Improve access to LTSS by bringing additional money into LTSS system, Reduce family out-of-pocket spending, Stabilize and improve the private market by reducing the tail-end risk and Reduce Medicaid spending. Legislative Proposals for Public LTSS Finance Coverage Reform Back-end, Back-end/Catastrophic, Cash benefit – no services defined, Largely federal role, Mandatory/universal, New program/separate administration, No age limits, None, None specified, Older adults (65+)
2021 Long Term Care Clearinghouse A comprehensive and interactive website was created as a companion
to OYF. Legislative Proposals for the Private Long-Term Care Insurance Market, Non-Tax Related Proposals to Expand Private Market Solutions Consumer Awareness and Education
2019 The National Academy for Social Insurance: Designing a State-Based Social Insurance Program for Long-Term Services and Supports Focuses on an analysis of social insurance solutions and intended as a roadmap for state policymakers. Identifies the key design issues for consideration in the design of a social insurance
program for LTSS. Speaks to the preliminary design and concepts of the Washington State LTSS social insurance program, Washington Cares (WA Cares). Commission Reports and Research Papers Back-end/Catastrophic, Cash benefit - no service defined, Catastrophic, Comprehensive, Comprehensive Coverage, Front-end, Home care and CC only, in proposal, Largely state role, Legislation estimate, Mandatory/universal, New Program/Separate Admin, Not specified/other, Older adults (65+), Other Financing
2018 Medicare Long-Term Care Services and Supports Act of 2018 Create a universal, catastrophic LTC insurance program meant to: Improve access to LTSS by bringing additional money into LTSS system, Reduce family out-of-pocket spending, Stabilize and improve the private market by reducing the tail-end risk and Reduce Medicaid spending. Legislative Proposals for Public LTSS Finance Coverage Reform Add-on to Medicare, Back-end/Catastrophic, Both federal and state, Cash benefit – no services defined, Mandatory/universal, None, None specified, not specified, Older adults (65+), Other Age Limits
2017 The American Long-Term Care Insurance Program: A Solution to Reduce Cost and Provide Stability Goals are to make private coverage more affordable for middle-income buyers, relieve
pressure on Medicaid budgets. Commission Reports and Research Papers Awareness campaign, Federally regulated exchange, Largely federal role, Lower distribution cost, No age limits, None specified, Not specified/other, Other Financing, Private Market Incentives, PRIVATE SECTOR INCENTIVES, Voluntary
2017 LeadingAge: A New Vision for Long-Term Services and Supports Goals to develop a fairer and more rational financing system to ensure access to quality LTSS. Recommends a flexible and universal LTSS insurance program grounded in the principles of shared risk and consumer flexibility. Re-directs health and LTC dollars already
in the system and creates new funding that relies on a universal public catastrophic
insurance program that insures against the risk of long periods of high need. Commission Reports and Research Papers Cash benefit - no service defined, Mandatory/universal, New Program/Separate Admin, None specified, Not specified/other
2015 Urban Institute: Microsimulation Analysis of Financing Options for Long-Term Services and Supports To assess alternative LTSS financing options and better understand how policy changes
could expand the role of insurance. Commission Reports and Research Papers Back-end/Catastrophic, Catastrophic, Comprehensive, Comprehensive Coverage, Dedicated/earmarked source, Front-end, Mandatory/universal, New Program/Separate Admin, Not specified/other, Older adults (65+), Other Financing, Voluntary
2015 Long-Term Care Financing Collaborative (LTCFC): Principles for Improving Financing and Delivery of Long Term Services and Supports Recommends a combination of public and private sector reforms: Universal catastrophic insurance program of financial support for those with extended LTC needs. Various initiatives to revitalize the private LTC insurance market to better address non-catastrophic care needs. Stronger support for family caregivers. Modernization of the Medicaid safety net for LTSS. Commission Reports and Research Papers Both state and federal, Catastrophic, Home care and CC only, in proposal, Legislation estimate, Medicaid enhancement, medicaid reform, New Program/Separate Admin, Not specified/other, Private Market Incentives, Tax clarification, Tighten Medicaid
2013 U.S. Senate Commission on Long-Term Care: Report to the Congress Section 643 of the American Taxpayer Relief Act of 2012 directed the Commission to develop a plan for the establishment, implementation, and financing of LTSS for individuals, including older adults, those with cognitive or functional limitations, and others who require assistance to perform ADLs.
Commission Reports and Research Papers Add-on to Medicare, Both state and federal, Catastrophic, Comprehensive, Dedicated/earmarked source, Federally regulated exchange, Include disabled, Legislation estimate, Mandatory/universal, New Program/Separate Admin, No age limits, None specified, Not specified/other, Older adults (65+), Other Financing, Private Market Incentives, Regulation change/new product, Reinsurance, Standardize policies, Subsidy for Medicaid opt-out, Tax clarification
2010 Community Living Assistance Services and Supports Act (CLASS) Creates a federally administered voluntary insurance program offering a cash benefit that eligible individuals can use to purchase various LTSS to enable them to continue to live in the community. Legislative Proposals for Public LTSS Finance Coverage Reform All adults (18+), Cash benefit – no services defined, CBO estimate, Comprehensive Coverage, Largely federal role, Legislation estimate, New program/separate administration, Other, Voluntary
2007 Georgetown University Long-Term Care Financing Project: Trade-Off Proposal for Funding Long-Term Care Following a cafeteria benefit model, public social insurance program that “trades” a small portion (5%) of individuals’ Social Security benefits to use for LTC coverage. It would create in the public sector a social insurance program for covering basic LTC by enabling people to exchange a small part of their income protection for LTC protection. Commission Reports and Research Papers Comprehensive, Dedicated/earmarked source, Mandatory/universal, New Program/Separate Admin, None specified, Not specified/other, Older adults (65+), Private Market Incentives
2006 Own Your Future Long Term Care Awareness Campaign The Own Your Future (OYF) Awareness Campaign was a joint federal-state effort to raise awareness about and planning for LTC. Legislative Proposals for the Private Long-Term Care Insurance Market, Non-Tax Related Proposals to Expand Private Market Solutions Consumer Awareness and Education
1994 Health Security Act (S.2357) Creates a state-based HCBS program for hospitalized individuals who need LTSS as an alternative to nursing facility placement. Clarifies favorable tax treatment of private LTC insurance and LTC expenses by treating policies as accident or health insurance contracts and assuring that payments are not taxable because they are treated as reimbursement for expenses actually incurred for medical care. Legislative Proposals for Public LTSS Finance Coverage Reform Both federal and state, CBO estimate, Home and community care only, Home care and CC only, Legislation estimate, Mandatory/universal, None specified, not specified, Other Age Limits, Transforming Healthcare Structures
1993 Health Security Act. Subtitle B. Long Term Care Expands Medicare by (1) extending Medicare Part A coverage to extended care services to chronically dependent individuals; and (2) providing coverage of home care services under Medicare Part B. Requires states to establish and support state plans to provide home and
community-based care to individuals with disabilities without regard to age or
income. Legislative Proposals for Public LTSS Finance Coverage Reform Add-on to Medicare, Both federal and state, CBO estimate, Home and CC only, Home and community care only, Legislation estimate, Mandatory/universal, None specified, not specified, Not specified/other, Other Age Limits, Transforming Healthcare Structures
1992 Comprehensive Care Act of 1992 Expands Medicare by providing: Medicare Part A coverage of facility care without requiring a prior hospital stay for chronically dependent individuals. Medicare Part B coverage of home care services to severely dependent individuals. Legislative Proposals for Public LTSS Finance Coverage Reform Add-on to Medicare, Comprehensive, Largely federal role, Mandatory/universal, None, None specified, not specified, Older adults (65+)
1992 Long Term Care Family Security Act of 1992 (H.R. 6076) Creates a new state-administered program to provide community and nursing facility
care to individuals with moderate to severe disability. Legislative Proposals for Public LTSS Finance Coverage Reform Both federal and state, Comprehensive, Legislation estimate, Mandatory/universal, New program/separate administration, No age limits, None specified, not specified
1991 The Pepper Commission: A Call for Action: Blueprint for Health Care Reform Proposes mandatory social insurance program for HCBS and the first three months of nursing facility care would be covered for all Americans, regardless of income. Commission Reports and Research Papers Both federal and state, in proposal, Legislation estimate, Mandatory/universal, New program, New Program/Separate Admin, None specified, Not specified/other, Not specified/other coverage, Older adults (65+), Tax clarification
1991 Secure Choice Act (H.R. 1668) Creates a new program that provides LTC services for older adults. Creates a statebased, public-private partnership LTSS program for older adults. Legislative Proposals for Public LTSS Finance Coverage Reform Both federal and state, Comprehensive, Mandatory/universal, New program/separate administration, None, None specified, not specified, Other Age Limits
1991 Universal Health Care Act (H.R. 1300) Creates a national, single-payer health insurance program, under which every U.S. citizen would be eligible for enrollment, that provides protection against the costs of health care and health-related services, including benefits for facility and home-based LTSS. Legislative Proposals for Public LTSS Finance Coverage Reform Both federal and state, Comprehensive, Home and CC only, Home and community care only, Legislation estimate, Mandatory/universal, New program/separate administration, No age limits, None, None specified, not specified, Other Financing
1991 MediPlan Long-Term Care Act (H.R. 651) Creates a “MediPlan” universal social insurance program within Medicare to provide coverage of LTSS for all U.S. citizens. Removes Medicare’s existing post-hospitalization requirement and extends nursing home coverage beyond the existing 100-day limit. Legislative Proposals for Public LTSS Finance Coverage Reform Add-on to Medicare, Comprehensive, Front-end, General appropriations (e.g. income tax), Largely federal role, Legislation estimate, Mandatory/universal, No age limits, None specified
1990 Lifecare Long-Term Care Protection Act (S. 2163) Creates the Lifecare Long-term Care Protection Program that would: Create state-based assessment and care management agencies to determine eligible individuals and maintain provider registries. Provide up to three years of home and community-based care. Provide up to six months of facility care (with the option for more). Create optional insurance program for longer facility care stays. Legislative Proposals for Public LTSS Finance Coverage Reform Both federal and state, Comprehensive, Dedicated/earmarked source (e.g., Front-end, Legislation estimate, Mandatory/universal, New program/separate administration, None specified, Older adults (65+), Other Age Limits, Social Security/ Medicare tax)
1988 Long-Term Care Assistance Act of 1988 (S. 2305) Establishes LTC benefits under Medicare Part B to cover chronic home care services, respite, and nursing care for eligible individuals. Provides chronic home and community-based care to severely disabled individuals under the existing Medicare program, with deductibles and cost-sharing for those who are not low-income. Legislative Proposals for Public LTSS Finance Coverage Reform Add-on to Medicare, Comprehensive, Comprehensive Coverage, Dedicated/earmarked source (e.g., Largely federal role, Legislation estimate, Mandatory/universal, None specified, Older adults (65+), Other, Social Security/ Medicare tax)
| Proposal Date | Proposals | Description | Category | |
|---|---|---|---|---|
| 2025 | Ronald Reagan Alzheimer’s Breakthrough Act of 2004 (S. 2533, H.R. 4595) | Same as S. 1335, but no cost estimate and does not include cafeteria plan/FSA. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | LTC and Retirement Security Act (S. 1335) | Companion bill to H.R. 6405 (above). Amend the IRC of 1986 to allow individuals a deduction for qualified LTC insurance premiums, the use of such insurance under cafeteria plans and flexible spending arrangements. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | LTC and Retirement Security Act, 2003 (HR 2096) | Companion bill to H.R. 6405 (above). Amend the IRC of 1986 to allow individuals a deduction for qualified LTC insurance premiums, the use of such insurance under cafeteria plans and flexible spending arrangements. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | Improving Long-Term Care Choices Act of 2005 (S. 1602) | Companion bill to H.R. 6405 (above). Amend the IRC of 1986 to allow individuals a deduction for qualified LTC insurance premiums, the use of such insurance under cafeteria plans and flexible spending arrangements. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | Long-Term Care Improvement Act of 2006 (H.R. 6405) | Amend the IRC to exclude from gross income distributions from an individual retirement account and other tax-exempt retirement plans used to pay LTC insurance premiums. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | LTC Act of 2005 (H.R. 976, S. 1706) | Amend the IRC to exclude from gross income distributions from an individual retirement account and other tax-exempt retirement plans used to pay LTC insurance premiums. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | Comprehensive LTC Support Act or 2006 (H.R. 6211) | Amend the IRC to allow a deduction from gross income (available for taxpayers who do not itemize deductions) for the cost of LTC premiums for the taxpayer and certain family members. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | LTC Tax Reduction Act (H.R. 4220) | Amends the IRC to exclude from gross income distributions from an individual retirement account and other tax-exempt retirement plans used to pay LTC insurance premiums. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | LTC Support and Incentive Act (H.R. 2935) | Amend the IRC to: (1) allow a tax deduction from gross income for 50% of the LTC premiums paid under a qualified LTC insurance contract for individuals under age 65 (increases the deduction percentage to 75% for premiums paid for individuals age 65+); (2) permit qualified LTC insurance contracts to be offered in a cafeteria plan and FSAs under certain conditions; (3) allow a nonrefundable tax credit of $4,000, subject to a phase-out for incomes exceeding $150,000 (joint returns) or $75,000 (individuals), for each individual age 65+ who has been certified as having LTC needs for at least 180 consecutive days in a taxable year and for whom the taxpayer is acting as a caregiver; and (4) mandate certain consumer protections for insurance contracts. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | LTC and Retirement Security Act of 2005 (H.R. 2682) | Amend the IRC to: (1) allow a tax deduction from gross income for LTC insurance premiums; (2) include LTC insurance in employee benefit cafeteria plans and flexible spending arrangements; (3) allow a tax credit for certain LTC costs; (4) set forth certain consumer protections for LTC insurance contracts; and (5) allow tax free exchanges of LTC insurance contracts. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | Amends the IRC of 1986 (H.R. 1150) | Allow individual taxpayers a tax credit for certain long-term health care insurance premiums and expenses paid for the taxpayer, the taxpayer’s spouse, or dependents. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | Healthcare Enhancement for Local Public Safety Retirees Act (H.R. 2177) | Amend the 1987 IRC to permit tax-free distributions up to $5,000 from government retirement plans for premiums for LTC insurance for public safety officers. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | Simple Cafeteria Plan Act (S. 723) | Allow premiums for LTC insurance to be paid on a pre-tax basis through section 125 cafeteria plans and FSAs. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | LTC Affordability and Security Act (H.R. 3363, S. 2337) | Allow premiums for LTC insurance to be paid on a pre-tax basis through section 125 cafeteria plans and FSAs. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | LTC Trust Account Act (S. 1809, H.R. 3088) | Allow individuals to use funds from 401(k), 403(b) and 457 plans to pay for LTC insurance without penalty for early withdrawal and without paying taxes on the amounts withdrawn. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | LTC Trust Account Act (S. 504) | Create a new type of savings account (a LTC Trust Account). Individuals can contribute up to $5,000/year and receive a refundable 10% tax credit on the contribution. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | Qualified LTC Fairness Act of 2007 (H.R. 2582) | Establish above-the-line tax deduction for LTC insurance and service expenses; does not require individuals to itemize deductions or have medical expenses that exceed 7.5% (now 10%) of AGI. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | Alzheimer’s Family Assistance Act of 2007 (S. 897) | Amend the IRC to provide a nonrefundable tax credit for LTC insurance premiums. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | LTC and Retirement Security Act of 2008 (H.R. 5559) | Amend the IRC to provide a nonrefundable tax credit for LTC insurance premiums. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | LTC Family Accessibility Act (S. 3365) | Amend the IRC to provide a nonrefundable tax credit for LTC insurance premiums. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | Tax Relief for LTC Act (H.R. 6237) | Amend the IRC to provide tax credit for LTC premiums and for family caregivers living with a family member or dependent with LTC needs. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | Simple Cafeteria Plan Act (S. 988) | Reintroduce S. 723 from 109th Congress. Amend the IRC of 1986 to allow small businesses to include LTC insurance in cafeteria plans. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | LTC Retirement and Security Act (H.R. 6005) | Create tax deduction for LTC insurance premiums, starting at 25% in 2013 and increasing to 65% in 2015, and 100% thereafter. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | LTC Affordability Act (S. 4820) | Amend the IRC to exclude up to $2,500/year from gross income distributions from eligible retirement plans if used to purchase LTC insurance or chronic illness benefit under a life insurance policy. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | Long-Term Care Partnership Program | The program allows Medicaid to disregard assets in an amount equal to the insurance benefit payments made under a Partnership-qualified (PQ) LTC insurance policy if and when someone with a PQ plan exhausted their private coverage and applied for Medicaid. | Legislative Proposals for the Private Long-Term Care Insurance Market, Non-Tax Related Proposals to Expand Private Market Solutions | Private Market Incentives, Private-Public Partnership |
| 2025 | Improving Access to Long-Term Care Insurance Act (H.R. 8820) | Allow taxpayers to take a deduction for LTC insurance premium amounts without satisfying the requirement that medical expenses exceed 7.5% of AGI. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Tax Deductions |
| 2024 | Mark Warshawsky, National Affairs: Financing Long-Term Care | Directs public program resources to those who cannot afford care and otherwise encourages self-reliance among those who could afford care through private funds or insurance. | Commission Reports and Research Papers | Awareness campaign, Medicaid enhancement, medicaid reform, No age limits, None specified, Not specified/other, Private Market Incentives, Tighten Medicaid, Transforming Structures |
| 2024 | The Brookings Institution: Home Care Benefit for Medicare | Develop and finance a universal home care benefit program for Medicare beneficiaries, which would have a measurable impact on access for individuals with functional and/or cognitive impairments who do not financially qualify for Medicaid. | Commission Reports and Research Papers | Add-on to Medicare, Home care and CC only, in proposal, Legislation estimate, Mandatory/universal, Not specified/other, Not specified/other coverage, Older adults (65+), Other Financing |
| 2024 | Amend Title XIX of the Social Security Act | Seeks to amend title XIX of the Social Security Act to enhance transparency and broaden coverage options for HCBS under Medicaid waivers. | Legislative Proposals for Public LTSS Finance Coverage Reform | Both federal and state, Home and CC only, Home and community care only, Mandatory/universal, Medicaid enhancement, No age limits, None, None specified, Not specified/other |
| 2023 | Amends Internal Revenue Code of 1986 (H.R. 5774) | Allow use of HSA funds for LTC expenses. By amending the Internal Revenue Code (IRC) of 1986 to Clarify Treatment of Distributions from Health Savings Accounts (HSAs) for LTC Services. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Use of HSA Funds |
| 2023 | HCBS Access Act | Expands access to HCBS and ends the Medicaid funding institutional bias by: Requiring state Medicaid programs to provide HCBS at the same level as they must cover nursing facility services. Eliminating the need for HCBS waivers when HCBS becomes a mandatory benefit. Creating additional programs and requirements to support providers who furnish HCBS. | Legislative Proposals for Public LTSS Finance Coverage Reform | Both federal and state, Home and CC only, Home and community care only, Legislative Proposals for Public LTSS Finance Coverage Reform, Mandatory/universal, Medicaid enhancement, medicaid reform, No age limits, None, None specified, Not specified/other |
| 2023 | Better Care Better Jobs Act | Creates new programs and funding for state Medicaid programs to improve HCBS and the direct care workforce by: Requiring states to submit an HCBS infrastructure improvement plan to increase access to HCBS and strengthen the direct care workforce. Increasing federal matching rate for HCBS in states that develop plans and meet specified benchmarks for improvements. | Legislative Proposals for Public LTSS Finance Coverage Reform | Both federal and state, Home and CC only, Home and community care only, Mandatory/universal, Medicaid enhancement, No age limits, None, None specified, Not specified/other |
| 2023 | Medicare for All Act (H.R.3421) | Establish a national, single-payer health insurance program to provide comprehensive protection against the costs of health care and health-related services, including a home and community-based LTSS benefit. | Legislative Proposals for Public LTSS Finance Coverage Reform | Add-on to Medicare, Both federal and state, Comprehensive, Home and community care only, Home care and CC only, Largely federal role, Mandatory/universal, No age limits, None, None specified, Not specified/other |
| 2022 | LTC Affordability Act (H.R. 7107) | Reintroduces S. 4820 from 116th Congress. Amend the IRC to expand the use of retirement plan funds for purchasing LTC insurance and for other purposes. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Use of Retirement Funds |
| 2022 | HELPS Retirees Improvement Act of 2022 (H.R. 7203) | Increases from $3,000 to $6,000 the amount of the exclusion from gross income of distributions from a tax-exempt retirement plan for health and LTC insurance for public safety officers. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Use of Retirement Funds |
| 2022 | Bipartisan Policy Center: An Updated Policy Roadmap: Caring for Those with Complex Needs | Federal Catastrophic Long-Term Care Insurance. Presents a mix of publicly funded programs and private insurance approaches to financing LTSS as a package of solutions designed to be financially and politically viable. | Commission Reports and Research Papers | Add-on to Medicare, Catastrophic, Comprehensive, Dedicated/earmarked source, Federally regulated exchange, Largely federal role, Mandatory/universal, Medicaid enhancement, medicaid reform, New Program/Separate Admin, New program/separate administration, None specified, Other criteria, Private Market Incentives, Regulation change/new product, Tax clarification, Transforming Structures |
| 2022 | Health Savings Freedom Act of 2022 (H.R. 6474) | Increases from $3,000 to $6,000 the amount of the exclusion from gross income of distributions from a tax-exempt retirement plan for health and LTC insurance for public safety officers. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Use of HSA Funds |
| 2021 | LTC Affordability Act (S. 2415) | Ability to use Retirement Account Funds to Pay for LTC insurance premiums without added 10% tax on early distributions. | Legislative Proposals for the Private Long-Term Care Insurance Market, Tax-Related Legislative Proposals to Expand Private Market Solutions | Use of Retirement Funds |
| 2021 | Milken Institute: New Approaches to Long-Term Care Access for Middle-Income Households | Goal to develop complementary public-private LTSS financing solutions focused on front-end protection provided by the state. Identifies three promising areas for increased financing and delivery opportunities: Medicare expansion solutions, Technology solutions, Public and private LTC insurance solutions. | Commission Reports and Research Papers | Add-on to Medicare, Comprehensive, Front-end, in proposal, Largely federal role, Legislation estimate, Older adults (65+), Private Market Incentives, Tighten Medicaid, Transforming Structures |
| 2021 | Well-Being Insurance for Seniors at Home Act (H.R. 4289) | Create a universal, catastrophic LTC insurance program meant to: Improve access to LTSS by bringing additional money into LTSS system, Reduce family out-of-pocket spending, Stabilize and improve the private market by reducing the tail-end risk and Reduce Medicaid spending. | Legislative Proposals for Public LTSS Finance Coverage Reform | Back-end, Back-end/Catastrophic, Cash benefit – no services defined, Largely federal role, Mandatory/universal, New program/separate administration, No age limits, None, None specified, Older adults (65+) |
| 2021 | Long Term Care Clearinghouse | A comprehensive and interactive website was created as a companion to OYF. | Legislative Proposals for the Private Long-Term Care Insurance Market, Non-Tax Related Proposals to Expand Private Market Solutions | Consumer Awareness and Education |
| 2019 | The National Academy for Social Insurance: Designing a State-Based Social Insurance Program for Long-Term Services and Supports | Focuses on an analysis of social insurance solutions and intended as a roadmap for state policymakers. Identifies the key design issues for consideration in the design of a social insurance program for LTSS. Speaks to the preliminary design and concepts of the Washington State LTSS social insurance program, Washington Cares (WA Cares). | Commission Reports and Research Papers | Back-end/Catastrophic, Cash benefit - no service defined, Catastrophic, Comprehensive, Comprehensive Coverage, Front-end, Home care and CC only, in proposal, Largely state role, Legislation estimate, Mandatory/universal, New Program/Separate Admin, Not specified/other, Older adults (65+), Other Financing |
| 2018 | Medicare Long-Term Care Services and Supports Act of 2018 | Create a universal, catastrophic LTC insurance program meant to: Improve access to LTSS by bringing additional money into LTSS system, Reduce family out-of-pocket spending, Stabilize and improve the private market by reducing the tail-end risk and Reduce Medicaid spending. | Legislative Proposals for Public LTSS Finance Coverage Reform | Add-on to Medicare, Back-end/Catastrophic, Both federal and state, Cash benefit – no services defined, Mandatory/universal, None, None specified, not specified, Older adults (65+), Other Age Limits |
| 2017 | The American Long-Term Care Insurance Program: A Solution to Reduce Cost and Provide Stability | Goals are to make private coverage more affordable for middle-income buyers, relieve pressure on Medicaid budgets. | Commission Reports and Research Papers | Awareness campaign, Federally regulated exchange, Largely federal role, Lower distribution cost, No age limits, None specified, Not specified/other, Other Financing, Private Market Incentives, PRIVATE SECTOR INCENTIVES, Voluntary |
| 2017 | LeadingAge: A New Vision for Long-Term Services and Supports | Goals to develop a fairer and more rational financing system to ensure access to quality LTSS. Recommends a flexible and universal LTSS insurance program grounded in the principles of shared risk and consumer flexibility. Re-directs health and LTC dollars already in the system and creates new funding that relies on a universal public catastrophic insurance program that insures against the risk of long periods of high need. | Commission Reports and Research Papers | Cash benefit - no service defined, Mandatory/universal, New Program/Separate Admin, None specified, Not specified/other |
| 2015 | Urban Institute: Microsimulation Analysis of Financing Options for Long-Term Services and Supports | To assess alternative LTSS financing options and better understand how policy changes could expand the role of insurance. | Commission Reports and Research Papers | Back-end/Catastrophic, Catastrophic, Comprehensive, Comprehensive Coverage, Dedicated/earmarked source, Front-end, Mandatory/universal, New Program/Separate Admin, Not specified/other, Older adults (65+), Other Financing, Voluntary |
| 2015 | Long-Term Care Financing Collaborative (LTCFC): Principles for Improving Financing and Delivery of Long Term Services and Supports | Recommends a combination of public and private sector reforms: Universal catastrophic insurance program of financial support for those with extended LTC needs. Various initiatives to revitalize the private LTC insurance market to better address non-catastrophic care needs. Stronger support for family caregivers. Modernization of the Medicaid safety net for LTSS. | Commission Reports and Research Papers | Both state and federal, Catastrophic, Home care and CC only, in proposal, Legislation estimate, Medicaid enhancement, medicaid reform, New Program/Separate Admin, Not specified/other, Private Market Incentives, Tax clarification, Tighten Medicaid |
| 2013 | U.S. Senate Commission on Long-Term Care: Report to the Congress | Section 643 of the American Taxpayer Relief Act of 2012 directed the Commission to develop a plan for the establishment, implementation, and financing of LTSS for individuals, including older adults, those with cognitive or functional limitations, and others who require assistance to perform ADLs. | Commission Reports and Research Papers | Add-on to Medicare, Both state and federal, Catastrophic, Comprehensive, Dedicated/earmarked source, Federally regulated exchange, Include disabled, Legislation estimate, Mandatory/universal, New Program/Separate Admin, No age limits, None specified, Not specified/other, Older adults (65+), Other Financing, Private Market Incentives, Regulation change/new product, Reinsurance, Standardize policies, Subsidy for Medicaid opt-out, Tax clarification |
| 2010 | Community Living Assistance Services and Supports Act (CLASS) | Creates a federally administered voluntary insurance program offering a cash benefit that eligible individuals can use to purchase various LTSS to enable them to continue to live in the community. | Legislative Proposals for Public LTSS Finance Coverage Reform | All adults (18+), Cash benefit – no services defined, CBO estimate, Comprehensive Coverage, Largely federal role, Legislation estimate, New program/separate administration, Other, Voluntary |
| 2007 | Georgetown University Long-Term Care Financing Project: Trade-Off Proposal for Funding Long-Term Care | Following a cafeteria benefit model, public social insurance program that “trades” a small portion (5%) of individuals’ Social Security benefits to use for LTC coverage. It would create in the public sector a social insurance program for covering basic LTC by enabling people to exchange a small part of their income protection for LTC protection. | Commission Reports and Research Papers | Comprehensive, Dedicated/earmarked source, Mandatory/universal, New Program/Separate Admin, None specified, Not specified/other, Older adults (65+), Private Market Incentives |
| 2006 | Own Your Future Long Term Care Awareness Campaign | The Own Your Future (OYF) Awareness Campaign was a joint federal-state effort to raise awareness about and planning for LTC. | Legislative Proposals for the Private Long-Term Care Insurance Market, Non-Tax Related Proposals to Expand Private Market Solutions | Consumer Awareness and Education |
| 1994 | Health Security Act (S.2357) | Creates a state-based HCBS program for hospitalized individuals who need LTSS as an alternative to nursing facility placement. Clarifies favorable tax treatment of private LTC insurance and LTC expenses by treating policies as accident or health insurance contracts and assuring that payments are not taxable because they are treated as reimbursement for expenses actually incurred for medical care. | Legislative Proposals for Public LTSS Finance Coverage Reform | Both federal and state, CBO estimate, Home and community care only, Home care and CC only, Legislation estimate, Mandatory/universal, None specified, not specified, Other Age Limits, Transforming Healthcare Structures |
| 1993 | Health Security Act. Subtitle B. Long Term Care | Expands Medicare by (1) extending Medicare Part A coverage to extended care services to chronically dependent individuals; and (2) providing coverage of home care services under Medicare Part B. Requires states to establish and support state plans to provide home and community-based care to individuals with disabilities without regard to age or income. | Legislative Proposals for Public LTSS Finance Coverage Reform | Add-on to Medicare, Both federal and state, CBO estimate, Home and CC only, Home and community care only, Legislation estimate, Mandatory/universal, None specified, not specified, Not specified/other, Other Age Limits, Transforming Healthcare Structures |
| 1992 | Comprehensive Care Act of 1992 | Expands Medicare by providing: Medicare Part A coverage of facility care without requiring a prior hospital stay for chronically dependent individuals. Medicare Part B coverage of home care services to severely dependent individuals. | Legislative Proposals for Public LTSS Finance Coverage Reform | Add-on to Medicare, Comprehensive, Largely federal role, Mandatory/universal, None, None specified, not specified, Older adults (65+) |
| 1992 | Long Term Care Family Security Act of 1992 (H.R. 6076) | Creates a new state-administered program to provide community and nursing facility care to individuals with moderate to severe disability. | Legislative Proposals for Public LTSS Finance Coverage Reform | Both federal and state, Comprehensive, Legislation estimate, Mandatory/universal, New program/separate administration, No age limits, None specified, not specified |
| 1991 | The Pepper Commission: A Call for Action: Blueprint for Health Care Reform | Proposes mandatory social insurance program for HCBS and the first three months of nursing facility care would be covered for all Americans, regardless of income. | Commission Reports and Research Papers | Both federal and state, in proposal, Legislation estimate, Mandatory/universal, New program, New Program/Separate Admin, None specified, Not specified/other, Not specified/other coverage, Older adults (65+), Tax clarification |
| 1991 | Secure Choice Act (H.R. 1668) | Creates a new program that provides LTC services for older adults. Creates a statebased, public-private partnership LTSS program for older adults. | Legislative Proposals for Public LTSS Finance Coverage Reform | Both federal and state, Comprehensive, Mandatory/universal, New program/separate administration, None, None specified, not specified, Other Age Limits |
| 1991 | Universal Health Care Act (H.R. 1300) | Creates a national, single-payer health insurance program, under which every U.S. citizen would be eligible for enrollment, that provides protection against the costs of health care and health-related services, including benefits for facility and home-based LTSS. | Legislative Proposals for Public LTSS Finance Coverage Reform | Both federal and state, Comprehensive, Home and CC only, Home and community care only, Legislation estimate, Mandatory/universal, New program/separate administration, No age limits, None, None specified, not specified, Other Financing |
| 1991 | MediPlan Long-Term Care Act (H.R. 651) | Creates a “MediPlan” universal social insurance program within Medicare to provide coverage of LTSS for all U.S. citizens. Removes Medicare’s existing post-hospitalization requirement and extends nursing home coverage beyond the existing 100-day limit. | Legislative Proposals for Public LTSS Finance Coverage Reform | Add-on to Medicare, Comprehensive, Front-end, General appropriations (e.g. income tax), Largely federal role, Legislation estimate, Mandatory/universal, No age limits, None specified |
| 1990 | Lifecare Long-Term Care Protection Act (S. 2163) | Creates the Lifecare Long-term Care Protection Program that would: Create state-based assessment and care management agencies to determine eligible individuals and maintain provider registries. Provide up to three years of home and community-based care. Provide up to six months of facility care (with the option for more). Create optional insurance program for longer facility care stays. | Legislative Proposals for Public LTSS Finance Coverage Reform | Both federal and state, Comprehensive, Dedicated/earmarked source (e.g., Front-end, Legislation estimate, Mandatory/universal, New program/separate administration, None specified, Older adults (65+), Other Age Limits, Social Security/ Medicare tax) |
| 1988 | Long-Term Care Assistance Act of 1988 (S. 2305) | Establishes LTC benefits under Medicare Part B to cover chronic home care services, respite, and nursing care for eligible individuals. Provides chronic home and community-based care to severely disabled individuals under the existing Medicare program, with deductibles and cost-sharing for those who are not low-income. | Legislative Proposals for Public LTSS Finance Coverage Reform | Add-on to Medicare, Comprehensive, Comprehensive Coverage, Dedicated/earmarked source (e.g., Largely federal role, Legislation estimate, Mandatory/universal, None specified, Older adults (65+), Other, Social Security/ Medicare tax) |